In October, SMR summarized a paper by Sundman et al that described how two commercial systems can generate platelet-rich plasma (PRP) preparations that have very different cellular and growth factor concentrations and therefore may have different therapeutic effects. To further explore this issue Mazzocca et al quantified the level of platelets, growth factors, red blood cells, and white blood cells in one-step (clinically-used commercial devices) and two-step separation systems. A secondary goal was to determine how consistent the PRP preparations were when the same patients contributed blood samples on different occasions. Eight healthy participants had blood drawn using a standardized protocol on three different days (baseline, 14 days later, and 30 days after baseline). The blood was transferred to three different separation systems: 1) PRP-1 (single-spin method expected to have lower platelet and white blood-cell number), 2) PRP-2 (single-spin method designed to have higher platelet and white blood-cell number), and 3) PRP-3 (double-spin method). PRP-2 led to preparations with higher concentrations of platelets, red blood cells, white blood cells, and most growth factors than the other methods. Interestingly, the authors found that all of the preparation methods led to PRP preparations with variable concentrations of cells and growth factors when multiple blood draws were prepared from the same patient.

This study, a nice complement to the paper by Sundman et al, further illustrates that PRP preparations can be very variable even when the same commercial system is used multiple times for a patient. It is unclear what might be causing the variability in preparations and what the implications may be. The authors note that the variability of PRP components and their effects on dosage should be considered with PRP treatments. Future research will need to assess when these different preparations are appropriate. When we read articles about the effectiveness of PRP injections it is important that we check what preparation system they used, what is the cellular and growth factor composition of the final product, and how variable might the composition be each day. Furthermore, when we are selecting commercial systems to prepare PRP we need to ask the companies these questions. Unfortunately, PRP preparation systems do not undergo the rigorous development and testing process like pharmaceutical products. This places the extra burden on the clinician to challenge the companies to address these concerns and for us to determine when certain preparations may be more appropriate than others. As more research shows the complexity of using PRP injections are you using PRP injections more or less today then you were a year ago?

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